For the initial discussion post, review the article by Miller, Drummond and Care
ID: 122239 • Letter: F
Question
For the initial discussion post, review the article by Miller, Drummond and Carey:
Miller, J., Drummond Haye, D., & Carey, K. W. (2015). 20 QUESTIONS: Evidence-based practice or sacred cow? Nursing, 45(8), 46-55. doi:10.1097/01.NURSE.0000469234.84277.95
Scenario:
You begin your career in an acute care hospital as a newly licensed RN. During your orientation, you observe your preceptor checking gastric feeding tube placement by injecting air and auscultating the abdomen, stopping continuous enteral tube feedings before a patient is turned or repositioned, and routinely inserting rectal tubes for patients with diarrhea. You know that ALL three (3) of these practices are currently NOT supported by nursing evidence. When asked, your preceptor responds, “This is the way we have always cared for patients with tube feedings and diarrhea.” You prepare to talk to this peer about necessary changes in nursing practice.
Initial Discussion Post:
Address the following:
Choose ONE (1) of the practices described in the scenario.
Describe how you will address this gap in nursing practice with your preceptor. Write out exactly what you might say to this RN to professionally address the current evidence for the nursing care of patients.
Include when and where you would communicate this information
Consider any additional information you might provide to your preceptor to support changing nursing practice
Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.
Explanation / Answer
The impact of evidence-based practice (EBP) has echoed across nursing practice, education, and science. The call for evidence-based quality improvement and healthcare transformation underscores the need for redesigning care that is effective, safe, and efficient.
Being certified RN i would follow and recommend the Evidence Based Prctice Medicine. In this perticular scenario i will finish the complete orientation and oberve the things happening are EBP based or not. Being a RN i will male list what are areas i need to guide and implement the EBP.
I will reachout the perceptor who is doing auscultation to check the placement of the gastric feeding tube, firstly i introduce about myself and ask her to introduce about herself. I will create friendly atmoshphere in a professional manner that she would pay attention to learn about new things.
There several methods to assess tube location. These include watching for signs of respiratory distress, visually assessing aspirate, and using pH testing, if available. Before the tube is used to administer feeding or medication, confirm the tube placement by X-ray. Radiographic confirmation is particularly important when small-bore tubes are used because they may produce no symptoms when incorrectly placed and usually require a stylet for insertion, which introduces the risk of tissue perforation if the tube is not correctly positioned. Once initial proper placement is confirmed by X-ray, mark the tube's exit site clearly with tape or a permanent marker.
Earlier nurses continue to use the auscultatory method to assess enteral feeding tube placement, whether out of habit or because of a lack of resources and time. Now nurses should assess feeding tube placement at four-hour intervals, using the following methods:-
- Measure the external portion of the tube
- Review routine chest and abdominal X-ray reports
- Observe changes in the volume and appearance of feeding tube aspirates
- Test the pH of aspirates (if pH strips are available)
- Obtain X-rays if tube placement is in doubt
Until a completely reliable, simple, and cost-effective means of assessing placement is available, nurses must be vigilant in using the best evidence to date.
The system of nursing documentation is very important EBP in nursing process, process of nursing is continuously changing to meet new demands, expectations and technology.
Plan the session for all the staffs coming in shift duties.When new graduates who have learned to take an evidence-based approach to care are meeting these nurses in real-world settings, they encounter this prevalence of a this is the way we do it here.
The choices and diversity of roles are endless in clinical practice, nurses can “show their scope of practice” no matter what their clinical specialty. In roles beyond the point of care, nurses bring their unique knowledge, caring and wisdom to all opportunities and situations.